Kodi opaleshoni yanu idzalemba?
Pali zinthu zambiri zomwe muyenera kuganizira musanapite pansi pa mpeni. Yoyamba, ndithudi, ndi ngati kapena opaleshoni yanu ndi yofunikira kapena ngati pali njira zina zothandizira. Pambuyo pake kumabwera momwe mungagwiritsire ntchito ndi opaleshoni yanu. Potsirizira pake, kodi inshuwalansi idzapindula ndalama zingati?
Musagwiritse ntchito opaleshoni iliyonse kapena njira yothetsera kusagwirizana nazo.
Monga zinthu zambiri pansi pa ambulera ya Medicare, sizinthu zonse zakuda ndi zoyera. Anthu ochepa amadziwa kuti Centers for Medicare ndi Medicaid (CMS) yakhazikitsa mndandanda wa opaleshoni yomwe idzagwiritsidwa ntchito ndi Medicare Part A pomwe opaleshoni zina, malinga ngati palibe mavuto, amatha kukhala ndi Medicare Part B. Izi sizikukhudza kokha Kodi mungapereke ndalama zochuluka bwanji koma opaleshoni yanu ikhoza kuchitidwa.
List of Only Inpatient Surgery List
Chaka chilichonse CMS imatulutsa mndandanda wa opaleshoni wokhazikika opaleshoni. Kuchita opaleshoni pamndandanda uwu sikusankhidwa mwachindunji. Chifukwa cha kuvuta kwa njirayi, chiopsezo cha mavuto, kufunika koyang'anira ntchito, komanso nthawi yowonjezera yowonongeka, CMS imadziwa kuti opaleshoniyi imafuna kusamalidwa bwino.
Zitsanzo za opaleshoni zokha opaleshoni ndizo:
- Mitsempha ya Coronary inalembera kuphatikiza (CABG)
- Gastric opaleshoni opaleshoni ya kunenepa kwambiri
- Kukonzekera kwa valve yamtima kapena m'malo mwa valve
Pofuna kupeza chitetezo cha odwala Medicare, opaleshoniyi iyenera kuchitidwa kuchipatala. Medicare Part A ikuphatikizapo kuchuluka kwa ndalama zopangira opaleshoni, ndipo iwe udzalipira deductible ($ 1,316 mu 2017).
Opaleshoni Yopangidwira Opaleshoni Yopaleshoni
Kuchita opaleshoni pafupipafupi mndandanda wodwala sangathe kuchitidwa mu Chiopsezo cha Ambulatory Center (ASC).
Ndipotu, CMS imafalitsa mndandanda wa ma opaleshoni ochiritsira omwe angakhoze kuchitidwa pa ASC. Mndandanda umenewu umatchedwa Addendum AA.
Mwakutanthawuza, ASC ndi chipatala chachipatala kumene opaleshoni imachitidwa. Zingatheke kapena sizigwirizana ndi chipatala. Mwinanso mungamve ASC zomwe zimatchedwa kuti malo opaleshoni a masiku omwewo.
Malingana ndi malangizo a CMS, "zizindikiro za opaleshoni zomwe zili m'gulu la ASC za njira zopangira opaleshonizi ndizo zomwe zatsimikiziridwa kuti sizikhala ndi mwayi waukulu kwa odwala Medicare ngati zakhala zoperekedwa mu ASCs ndipo sizikuyembekezeredwa kuti zikhale zofunikira zothandizira kuchipatala pakati pausiku a tsiku limene opaleshoni ikuchitidwa (usiku wonse). "Mwachidule, opaleshoni izi ndizoopsa kwambiri ndipo siziyembekezeredwa kuti zizisamalidwa ndi kupitirira maola 24.
Zitsanzo za njira zomwe zingatheke ku ACS zikuphatikizapo:
- Kuchotsa Cataract
- Colonoscopy ndi yopanda biopsy
- Jekeseni wa Epidural kwa ululu wammbuyo
- Prostate biopsy
- Mankhwala opweteketsa a impso
Opaleshoniyi idzagwiritsidwa ntchito ndi Medicare Part B, ndipo mudzawerengedwa 20 peresenti ya zonse.
Kulemba Opaleshoni ya CMS ndi Chitetezo cha Odwala
Mndandanda wa opaleshoni yokha opaleshoni yokhayo sikutanthauza kubwezera; Komanso ndi za chitetezo.
Kugwira ntchito kuchipatala ndi chosiyana kwambiri ndi mu ASC. Ngakhale chipatala chiri ndi maola 24, ASC ikhoza kuchepetsa antchito usiku wonse. Ma ASC ambiri sadzakhala ndi dokotala pa malo pambuyo pa maola.
Ngati pali mavutowo pambuyo pa maola ambiri, nkokayikitsa kuti ASC ikhoza kukhala ndi zoyenera komanso antchito omwe angathe kuyisamalira. Izi zingafunike kutumiza wodwala kuchipatala chapafupi. Popeza kusamalidwa mu ASC kumangokhala maola 24, ngati wodwalayo akufuna nthawi yochulukirapo, wodwalayo amafunikanso kupita kuchipatala.
Pazifukwa izi, njira zonse za mndandanda wa Inpatient Only ziyenera kuchitidwa kuchipatala.
Komabe, izo sizikutanthauza kuti opaleshoni zina sizidzachitidwa kuchipatala. Ngati opaleshoni sichipezeka pa mndandanda wokhawokha koma osati pazowonjezera AA, iyenso iyenera kuchitidwa kuchipatala.
Kuyerekezera Medicare Wachibadwidwe ndi Medicare Thandizo
Traditional Medicare ( Gawo A ndi Gawo B ) ndi Medicare Advantage (Gawo C) amatsatira malamulo osiyana. Ngakhale kuti Medicare yachikhalidwe ikutsatira ndondomeko zonse zothandizira zomwe zafotokozedwa pamwambapa, mapulani a Medicare Advantage sayenera. Angasankhe kulipira opaleshoni ngati odwala kapena odwala, mwachitsanzo, perekani mocheperapo, mosasamala kanthu kuti akukhala mu list of Only Inpatient. Izi zingakugwetseni mavuto azachuma.
Mosasamala mtundu wa Medicare omwe mukukonzekera kuti muli nawo, opaleshoni yokhala mu list of Inpatient Only ayenera kuchitidwa kuchipatala.
Pakhoza kukhala phindu kukhala ndi dongosolo la Medicare Advantage. Ganizirani chisamaliro chokonzekera pambuyo pa opaleshoni yanu. Kuti Medicare yachikhalidwe ikhopirire kuti mukhalebe ndi malo osungirako odwala, muyenera kulandira masiku osachepera atatu ngati odwala. Mankhwala a Medicare Advantage ali ndi mwayi wosamvera malamulo a masiku atatu. Izi zikhoza kukupulumutsani kwambiri mu ndalama zowonetsera ngati chipatala chanu chifupika nthawi yaitali.
Mawu Ochokera
Medicare sichita opaleshoni yonse mofanana. Mndandanda wa opaleshoni wochiritsidwa wokhawokha umatulutsidwa chaka chilichonse ndi CMS. Njirazi zimavomerezedwa kuti gawo la A lichitike ndipo liyenera kuchitidwa kuchipatala. Ma opaleshoni ena onse, malinga ngati palibe mavuto, ali ndi gawo B.
CMS imatulutsanso Zowonjezeredwa za AA zomwe zimatchula zomwe zilipo (mwachitsanzo, osati njira zochiritsira zokha) zomwe zingathe kuchitidwa muzipatala zamakono. Ma opaleshoni onse otsala omwe ayenera kukhala opaleshoni ayenera kuchitidwa kuchipatala kwa aliyense pa Medicare.
Pezani momwe gulu lanu likuyendera mkati mwamsanga kuti muthe kukonzekera bwino ndi kupeĊµa zovuta zina.
> Zotsatira:
> Zopangira Opaleshoni Zolimbitsa Thupi. Centers for Medicare ndi Medicaid Services. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/ASCs.html. Idasinthidwa pa October 20, 2016.
> Malamulo apamtundu wa Federal Regulations: Mutu 42 - Mutu IV - Wowonjezera B - Gawo 416: Ntchito Zopangira Opaleshoni. Ofesi Yoyang'anira Boma la US. https://www.ecfr.gov/cgi-bin/text-idx?c=ecfr&sid=38af2161b33de70fc35286fdbee57ca6&rgn=div5&view=text&node=42:3.0.1.1.3&idno=42#PartTop. Idasinthidwa pa October 12, 2017.
> FY 2017 IPPS Yoyamba Kulamulira Page. Centers for Medicare ndi Medicaid Services. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2017-IPPS-Final-Rule-Home-Page.html. Kusinthidwa pa March 7, 2017.
> Medicare Program: Mchipatala Wopereka Mpata Wopereka Ngongole ndi Pulogalamu Yopangira Opaleshoni Amalipiritsa Mapulogalamu Athu ndi Mapulogalamu Abwino. Federal Register. https://www.federalregister.gov/documents/2017/07/20/2017-14883/medicare-program-hospital-outpatient-prospective-payment-and-ambulatory-surgical-center-payment. Idasindikizidwa pa July 20, 2017.